Network for Education and Support in Immunisation Report NESI... · GAVI Global Alliance for...

Network for Education and Support in Immunisation

Saving lives through immunisation

ANNUAL REPORT 2013

4 List of abbreviations 7 Foreword 8 Highlight 2013 11 About NESI 15 Chapter 1: Education and Training 15 1.1. In-service training 20 1.2. Pre-service training 22 1.3. Development of training materials29 Chapter 2: Technical support: Institutional strengthening 35 Chapter 3: Networking and advocacy 35 3.1. Meetings 39 3.2. Symposia 41 3.3. Advocacy events 42 NESI Oversight Committee Meeting 44 Publications 46 Colofon

AMP Agence Médicine Préventive

CDC Centers for Disease Control and Prevention

CRS Congenital Rubella Syndrome

DRC Democratic Republic of Congo

ECTS European Credit and Transfer Accumulation System

EMR Eastern Mediterranean Region

EPI Expanded Programme on Immunization

GAVI Global Alliance for Vaccines and Immunization

GIVS Global Immunisation Vision and Strategy

GVAP Global Vaccine Action Plan

HCW Healthcare workers

HepB Hepatitis B

Hib Haemophilusinfluenzaetypeb

HIV HumanImmunodeficiencyVirus

HPV Human Papillomavirus

HSV Herpes Simplex Virus

ICATT IMCI Computerised Adaptation and Training Tool

IMCI Integrated Management of Childhood Illnesses

IPV Inactivated Polio Vaccine

IVI International Vaccine Institute

MCHIP Maternal and Child Health Integrated Program

MDG Millennium Development Goal

MLM Mid-Level Management

MoH Ministry of Health

MoU Memorandum of Understanding

MPH Master of Public Health

MSc Master of Science

MSF Médecins Sans Frontières

NDoH National Department of Health

NESI Network for Education and Support in Immunisation

NGO Non-Governmental Organisation

NIAID National Institute of Allergy and Infectious Diseases (U.S.)

List of abbreviations

NITAG National Immunisation Technical Advisory Group

ONDE l’Observatoire National des Droits de l’Enfant

PAHO Pan American Health Organization

PCV Pneumococcal Conjugate Vaccine

RTAG Regional Technical Advisory Group

SAGE Strategic Advisory Group of Experts

SAVIC South African Vaccination and Immunisation Centre

SOMIPEV Société Marocaine d’Infectiologie Pédiatrique et de Vaccinologie

STI Sexual Transmitted Infection

TB Tuberculosis

UAntwerp University of Antwerp

UCT University of Cape Town

UNICEF United Nations Children’s Fund

UNICEF/ESARO UNICEFEasternandSouthernRegionalOffice

UNICEF/WCARO UNICEFWesternandCentralRegionalOffice

USAID United States Agency for International Development

VACFA Vaccines for Africa Initiative

VPD Vaccine-preventable disease

WHO World Health Organization

WHO/AFRO WHORegionalOfficeforAfrica

WHO/EMRO WHORegionalOfficefortheEasternMediterranean

WHO/HQ WHO Headquarters

WHO/IVB WHO Department on Immunisation, Vaccines and Biologicals

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Dear colleagues,

We are pleased to present our annual report on the activities implemented during 2013 by the Network for Education and Support in Immunisation (NESI). This report summarizes the achievements of the Network in the area of capacity building in immunisation, focusing on the African and Eastern Mediterranean Regions of the World Health Organization.

Vaccinationisoneofthemostsuccessfulandcost-effectivewaysofpreventingmorbidityandmortality against an increasing number of infectious diseases. To deliver quality immunisation services to the public, a national immunisation programme relies on the support of well-trainedmedicalandnursingstaff.Therefore,healthtraininginstitutionsplayanessentialandactive role in the implementation of the Network’s activities.

The major highlight of 2013 was the celebration of 10 years NESI. For this occasion, a Symposium was organised at the University of Antwerp in Belgium. I would like to sincerely thank all the speakers for their contribution to make this Symposium a great success.

Following thesuccessfulestablishmentof thefirst focaloffice in2012at theUniversityofLimpopo, South Africa, institutional strengthening remained high on the agenda during 2013. A Memorandum of Understanding was signed with SOMIPEV, an umbrella organisation including all medical faculties in Morocco, with headquarters at the University of Marrakech. DiscussionsstartedwiththeUniversityofJordantoestablishafocalofficeandafirstjointproject has been started.

Another area that received major attention during 2013 was the revision of the immunisation prototype curricula for medical and nursing/midwifery schools. The incorporation of EPI into undergraduatetrainingwillenablestudentstodevelopafirmbasisofcoreEPIknowledgeand skills and is important towards strengthening immunisation programmes.

I would like to thank all members of the NESI Oversight Committee for their continued support, as well as our sponsors and other partners. Our achievements were made possible thanks to close collaboration with many partners in immunisation, including universities, governments, multilateral and bilateral organisations, industry, non-governmental organisations and alliances. We are looking forward to a continuation of this fruitful collaboration, to contributing to the Millennium Development Goals and the Decade of Vaccines, and to maximising the benefitsofimmunisationtoall.

Sincerely,

Dr Carine Dochez

Programme Director

Foreword

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Highlight 2013

Symposium 10 years NESI on 22 April 2013

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The Network for Education and Support in Immunisation (NESI) was established in 2002. NESI was built on the experience of the International Network for Eastern and Southern Africa onHepatitisBVaccination,whichwasestablishedin1999byfiveuniversitiesinEasternandSouthern Africa (Kenya, Tanzania, Zambia, Zimbabwe and South Africa), Ministries of Health in Africa and the University of Antwerp. The purpose of this network was to translate research on hepatitis B through capacity building and advocacy into universal access to hepatitis B vaccination in the partner countries.

With the development of new vaccines and increased commitment by development partners and private sector initiatives to strengthen vaccine supply and immunisation services, there are more opportunities to prevent more diseases in more children. This led to the establishment of NESI, which is a collaborative network of capacity building for the strengthening of existing immunisation systems and introduction of new vaccines with a broad technical scope and wide geographical focus.

NESI closely coordinates its activities with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the Global Alliance for Vaccines and Immunization (GAVI Alliance), Non-Governmental Organisations (NGOs), the private sector, and other immunisation stakeholders.

Due to its links with universities and other health professional training institutions, which are vitaltoachievingsustainablecapacityandcompetencebuildinginthefieldofvaccinology,NESI is unique in its attention on pre-service training, particularly on the development of curricula and training for nurses, medical doctors, pharmacists, public health specialists and other related health professionals.

AMemorandumofUnderstandingbetweenNESIand theWHORegionalOffice forAfrica(WHO/AFRO)clearlydefines theoverallgoalsandactionsofNESI in theareaofcapacitybuilding. With the Eastern Mediterranean Region of WHO (WHO/EMRO), NESI works on the basis of a detailed annual joint plan of action for key areas of capacity building. This validates the position of NESI as an integral partner in capacity building within the WHO African and Eastern Mediterranean Regions.

MissionThe mission of NESI is to improve the quality and sustainability of immunisation programmes and services in low- and middle-income countries through capacity building, education and training, institutional strengthening and building international networks. NESI aims to build thecapacityofMinistryofHealthmanagersandstaffworkingintheExpandedProgrammeon Immunization (EPI) in their respective countries as well as to improve pre-service and post-graduate training at the different faculties of health training institutions involved inimmunisation, which include medicine, nursing, pharmacy, and public health.

About NESI

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StrategiesTo accomplish its mission, NESI engages in a number of activities, which are grouped into three main areas: education and training, technical support, and networking and advocacy. NESI offers the following in each area:

1. Education and training

• Organises training events in collaboration with other organisations;

• Monitors and evaluates currently implemented education and training programmes;

• Validates the content of educational and training materials;

• Develops up-to-date, high-quality training materials for different audiences involved inimmunisation programmes; and

• Provides support to universities to improve the curriculum of health professionals involved in immunisation and advises on regular refresher courses in collaboration with Ministries of Health (MoH).

2. Technical support

• Performs training needs assessments in collaboration with academic and other partners;

• Assists countries in developing comprehensive training plans as part of their Multi-Year Plans;

• Providessupporttocountrystafftoimplementtrainingactivities;and

• Supports institutional strengthening to improve national and regional capacity to deliver education and training.

3. Networking and advocacy

• Facilitates a forum to discuss and coordinate actions related to education, training, and support for immunisation programmes in low- and middle-income countries;

• Maintains a network of specialists drawn from international organisations, universities in both industrialised and developing countries, national immunisation programmes, NGOs, industry, and other relevant stakeholders, to deliver high-quality training in all aspects of immunisationandatdifferentstagesofimplementationofimmunisationprogrammes;

• Collaborates with local, regional, and global training initiatives to advocate for better education and training; and

• Offersawebsitethathousestrainingmaterialsandlinkstootherrelevantsites.

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StructureNESI is a partnership between the University of Antwerp and the public and private sector. An Executive Secretariat coordinates and implements activities for the network. The Executive Secretariat is based at the Department of Epidemiology and Social Medicine, University of Antwerp, Belgium.

The Executive Secretariat reports to the Oversight Committee, which advises on strategy and budget allocation, and reviews outcomes. The Oversight Committee is composed of representatives from this partnership, representatives of partner universities and international health organisations and alliances, and international vaccinology experts.

NESIhasfulloperationalandscientificindependence.

FundingNESI is currently supported by an educational grant from GlaxoSmithKline Biologicals and by funds from the University of Antwerp which also provides infrastructure, ICT, administrative and legal support. Additional funding, participation or support from other national or international agencies or partners is actively pursued.

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Education and Training 15

CHAPTER 1 Education and training

Human resources are key to providing good quality healthcare services to the population. A national immunisation programme relies heavily on the support of well-trained medical and nursingstaff,sothatallchildrenwillbenefitof receivingtherightvaccineat theright timein the right way. Therefore, training of health personnel must be relevant to national needs. Education and training must be coordinated and integrated with the developing health system as it moves towards meeting the objectives of health for all in the 21st century included in the Millennium Development Goals (MDGs), in the Global Immunisation Vision and Strategy (GIVS) adopted by the 58th World Health Assembly in 2005, and in the Global Vaccine Action Plan outlined in the Decade of Vaccines adopted at the 65th World Health Assembly in 2012.

Attention needs to be given to both in- and pre-service education and training. National immunisation programme reviews and training needs assessments indicate that serious bottlenecks exist between in-service and pre-service training: e.g. EPI content is not outlined in the pre-service curricula or is incomplete or outdated; health training institutions often lack demonstration equipment, as well as current EPI reference materials; there is inadequate time allocation for EPI theory; some lecturers lack knowledge on current EPI theory and practice.

Providing health care workers and academics with up-to-date information on vaccines and immunisation, is key to building the technical and managerial capacity and skills of current and future healthcare workers to deliver quality immunisation services to the public.

1.1. In-service training

To build the technical and managerial capacity and skills of current healthcare workers to deliver quality immunisation services

Tobeeffective,anational immunisationprogrammereliesonthesupportofwell-informedmedical, nursing and support staff. To provide immunisation services of good quality itis essential to have aworkforce that is sufficient in numbers,well-educated and trained,adequately deployed and motivated. Evaluation of Mid-Level Management (MLM) courses has clearly shown that the performance of healthcare workers improves after in-service training.

1.1.1. Vaccinology coursesIn-service vaccinology courses are key to build national vaccinology expertise by strengthening the capacity of academics in vaccinology (involved in teaching/research related to infectious diseases, mother and child health care, vaccines and immunisation) and to guide policy makers and programme managers to make evidence-based decisions on: (1) immunisation policies and strategies; (2) introduction of new vaccines and technologies; (3) sustaining and strengthening routine immunisation; (4) adjustments of existing immunisation programmes (e.g. adolescent vaccination); (5) adjustments to vaccination schedules; (6) conducting phase

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1 to phase 3 clinical trials, and post-marketing surveillance (phase 4 studies).

The target audience of vaccinology courses are: (1) teachers at health training institutions from thedifferent faculties involved in immunisation:medicine, nursing, public health andpharmacy; (2) Members of the National Immunisation Technical Advisory Groups (NITAG); (3)EPImanagers;(4)MoHsupportstaff;(5)staffofmultilateral(WHO,UNICEF)andbilateralorganisations, and of NGOs; and (6) MSc/MPH students.

The general objective of the vaccinology course is ‘’to master the basic principles and specificities of a vaccine, how it is developed, produced and utilised, including its use within the EPI programme’’.

The vaccinology courses are in principle built around 9 themes:

Lecturers in the vaccinology courses are leading international vaccinology experts from universities, WHO, UNICEF, GAVI Alliance, Ministry of Health and industry.

The scientific basis of vaccinology

Vaccine development and evaluation

Prequalification, registration, production and control

Routine EPI vaccines and optimising the impact of immunisation

New vaccines

Future vaccines

Vaccine safety and cost-effectiveness

Programmatic issues for new vaccine introduction

Training and research


1.1.1.1. “TropEd” Advanced Vaccinology Course, Berlin, Germany, January 2013

The TropEd Advanced Vaccinology Course was organised by the Institute of Tropical Medicine and International Health, Berlin, and NESI/UAntwerp, from 7 to 11 January 2013 in Berlin, Germany. The course is an accredited module (2 ECTS credit points) in the TropEd Masters Programme in International Health. TropEd is a network of institutions for higher education in International Health, including European and non-European institutions.

Sixteen students from both industrialised and developing countries attended the course.

Lecturers came from the Universities of Cape Town and Limpopo (South Africa), GAVI Alliance (Switzerland), Ministry of Health of Ghana, Robert Koch Institute (Berlin, Germany), Institute of Tropical Medicine and International Health (Berlin, Germany), London School of Hygiene and Tropical Medicine (UK), WHO/HQ (Switzerland), GlaxoSmithKline (Belgium) and NESI/UAntwerp (Belgium).

Teachingmethodsincludedseminar-styleandinteractivelectures,andgroupworkonspecifictargetdiseases.Studentsalsohadtowritea5-pageessayonaself-definedtopicrelevanttovaccines and immunisation, in order to obtain the ECTS credits. The essays were evaluated by the course organisers.

NESIstaffgave lectureson the following topics:Global ImmunisationVisionandStrategy(GIVS); Immunisation and Millennium Development Goals (MDGs); The decision-making process for new vaccine introduction; HPV vaccines; Adolescent vaccination; and Immunisation training and education. NESI also co-facilitated the group work and chaired several sessions.

In addition to the TropEd Advanced Vaccinology Module, NESI is also involved in lecturing at the TropEd Core Course in Berlin, Germany, which runs from September till December each year. NESI was invited to lecture on “Basic Vaccinology”, which is a one-day session during the Core Course.

1.1.1.2. The 13th International Advanced Course on Vaccinology in Asia-Pacific region, Seoul, Korea, May 2013

The 13th International Advanced Course on Vaccinology in the Asia-Pacific Region, organised by the International Vaccine Institute (IVI), was held from 13 to 18 May 2013, in Seoul, Korea.

The course aimed to strengthen the capacity of participants in vaccinology by providing a comprehensive overview of the vaccine continuum, from vaccine development, evaluation and regulatory principles, to production, post-licensure, introduction and policy issues.

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This course, that is relevant for both the public and private sector, was intended for scientists and decision-makers involved in vaccine development, in the elaboration of new vaccination strategies or in policy decisions related to the introduction of new vaccines in public health programmes, at national or international levels.

A total of 67 participants from 22 countries attended the course: Bangladesh, China, DRC, Ethiopia, India, Indonesia, Japan, Kenya, Korea, Madagascar, Mali, Nepal, Nigeria, Pakistan, Saudi Arabia, Sri Lanka, Sudan, Taiwan, Thailand, The Gambia, Turkey, and Vietnam. The participantswere a diversemix, consisting of scientists, public health officials and policymakers from private and public sectors.

Participants discussed historical perspectives of vaccines, new advances in vaccine research and development, and ethical principles in the design and conduct of vaccine studies and advocacy of vaccination, among other topics. The course focused on the vaccine development process, the method for vaccine evaluation and provided information on a range of vaccine-preventable diseases.

Lectures by leading experts in vaccinology, roundtable discussions, and interactive case studies were conducted on a wide range of disciplines, including epidemiology and immunology, the latest in vaccine technology, regulatory issues, and vaccine economics andfinancing.ThirtyexpertsfromIVI,universities,researchinstitutions, industry,non-profitorganisations, and international agencies served as faculty members. NESI was invited by IVI to give a lecture on “Vaccination schedules: history and rationale”, and to chair 2 sessions.


1.1.1.3. Regional Vaccinology Course for Anglophone countries, Pretoria, South Africa, May 2013

The 5th Regional Vaccinology Course for Anglophone countries was organised by WHO/AFRO in collaboration with the National Department of Health (NDoH) of South Africa, SAVIC/University of Limpopo, UNICEF, GAVI Alliance, USAID and NESI/UAntwerp, from 27 May to 1 June 2013 in Pretoria, South Africa.

Lecturers included national and international vaccinology experts from universities (Ghana, Senegal, South Africa), Ministries of Health, WHO, UNICEF and NESI/UAntwerp. Teaching methodsincludedseminar-styleandinteractivelectures,andgroupworkonspecifictargetdiseases.

NESI staff lecturedon the following topics:HepatitisB vaccines;Haemophilus influenzaetype b vaccines; HPV vaccines; Adolescent vaccination; Basic epidemiological concepts; Cost-effectivenessofvaccines;Managingnewvaccineintroduction;andInnovativecapacitybuildingeffortsforenhancingimmunisationsystems.NESIalsoco-facilitatedthegroupworkand chaired two sessions.

The course was attended by 42 participants from 19 countries: Botswana, Eritrea, Ethiopia, Ghana, Kenya, Lesotho, Liberia, Malawi, Namibia, Nigeria, Rwanda, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe; and included EPI managersandotherEPIstaff,academics,WHOandUNICEFfocalpoints.

The course was well appreciated by participants and created lively discussions. The overall evaluation score was above the threshold level of 70%: content (91%); facilitation (84%) and participation (73%).

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1.1.1.4. 9th Annual African Vaccinology Course, Cape Town, South Africa, November 2013

Since 2005, NESI has been involved in building capacity in vaccinology for the Southern African sub-region through annual vaccinology courses with the University of Cape Town (UCT), South Africa, as local organiser. The 9th African vaccinology course was organised in Cape Town, South Africa, from 25 to 29 November 2013, and was hosted by the Vaccine for Africa Initiative (VACFA), based at UCT’s Institute for Infectious Diseases and Molecular Medicine.

The objectives of the course were to introduce participants to the various disciplines associated with vaccinology including vaccine development, immunology, microbiology, clinical trials, safety, ethics, economics, evidence-based medicine, advocacy and communication, and immunisation programmes. At the end of the course, participants will have the necessary expertise to support national immunisation programmes, and to support high quality phase I-IV vaccine trials in Africa.

The course was attended by 59 participants from 19 African countries, with the following profile:EPImanagersandstaff,medicaldoctors,nurses,publichealthspecialists,academicsandscientistsworkinginthefieldofvaccinology.

Lecturers includedexperts in thefieldofvaccinology fromacademia, industryandprivatepractice. NESI gave lectures on the following topics: Vaccination schedules; and Hepatitis vaccines. NESI was also part of the “meet the experts” session, a session that allowed for questions and discussions.

1.2. Pre-service training

To build the technical and managerial capacity and skills of future healthcare workers to deliver quality immunisation services

The incorporation of EPI into undergraduate medical education, nursing/midwifery, and other health professional training programmes is important towards improving and strengthening immunisation service delivery, logistics, surveillance, communication and management practices. Clinical and public health training that incorporates the learning objectives of EPI willenablestudentstodevelopafirmbasisofcoreknowledgeandskills.

The rapid development of innovations and new technologies in immunisation programmes requiresthatgraduatestudents,astomorrows’staffs,areupdatedregularlyiftheyhavetocope with strategic changes and technical advancements.

Training needs assessments conducted in various countries of the WHO African Region during the last decade pointed out several challenges in pre- and in-service training of immunisation theory and practice at medical and nursing schools. Some of these challenges required concerted action by the schools and national immunisation services to deal with deficienciesinimmunisationteaching.


This situation prompted a systematic revision of EPI curriculum for both medical and nursing/midwifery schools. To facilitate this exercise, two EPI prototype curricula for medical and nursing/midwifery schools were developed in 2006 by WHO/AFRO and NESI, are available in English and French and have been widely distributed. The general objective of the prototype curricula is to strengthen the teaching and learning of immunisation within the existing curriculum for pre-service education programmes for medical doctors, nurses/midwives and other health professionals.

1.2.1. Regional workshop to revise EPI prototype curricula for medical and nursing/midwifery schools, Grand-Bassam, Ivory Coast, May 2013

A regional workshop to revise the EPI prototype curricula for medical and nursing/midwifery schools in the African Region was organized by WHO/AFRO in collaboration with the Ministry of Health of Ivory Coast, GAVI Alliance, UNICEF, MCHIP/USAID, AMP and NESI/UAntwerp, in Grand-Bassam, Ivory Coast, from 13 to 17 May 2013.

The evaluation of the introduction of the 2006 EPI prototype curricula into African health training institutions conducted in 2011 within 9 countries pointed out that:

1. there is still a bottleneck between EPI pre- and in-service training;

2. the EPI content covered is not always updated and does not include new content related to the Decade of Vaccines/Global Vaccine Action Plan (GVAP) and current new vaccines;

3. EPI content was either not outlined in the curricula or was incomplete;

4. updated reference materials and demonstration equipment were lacking; and

5. lecturers and tutors lacked modern EPI training.

To address these issues, a bilingual regional workshop was organised in Ivory Coast to revise and update the EPI prototype curricula for medical and nursing/midwifery schools.

The objectives of the workshop included:

• To update participants on the current immunisation policy and strategies, including GIVS and GVAP.

• To get a consensus on the content of the EPI prototype curricula to be revised for both medical and nursing/midwifery school in the African Region.

• To make recommendations for the implementation of the EPI curricula revision process within the African health pre-service training institutions.

A total of 69 participants and facilitators attended the workshop. Participants came from the following 26 countries: Angola, Benin, Burkina Faso, Burundi, Cameroun, Congo, DRC, Ethiopia, Gabon, Ghana, Guinee-Conakry, Ivory Coast, Kenya, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Liberia, Uganda, Senegal, South Africa, Tanzania, Togo and Zimbabwe. Among the participants were 32 lecturers from medical and nursing/midwifery schools. The workshop was facilitated by WHO, UNICEF, USAID, AMP and NESI. Four translators ensured the correct translation between English and French.

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Thefirstsessioncoveredplenary lectures toupdateparticipantson thenewpoliciesandguidelines and current new vaccines; to refresh participants on the content of the current EPI prototype curricula; to share with participants the results of the 2011 evaluation of the introduction of the EPI curricula in health training institutions; and to share country experiences regarding EPI curriculum introduction.

Following the plenary session, participants were divided into 4 groups to get a consensus on the EPI content to be revised and to make recommendations for the implementation of the EPI curricula revision process at African health training institutions: Medical schools in Anglophone countries; Medical schools in Francophone countries; Nursing schools in Anglophone countries; Nursing schools in Francophone countries. The meeting concluded with a plenary session compiling the feedback and recommendations from the 4 working groups and to set a timeline for completing the EPI prototype curriculum revision process and starting the introduction of the revised curricula in African health training institutions.

The workshop was highly appreciated by the participants and the overall evaluation was above the 70% satisfaction threshold: content (86%); facilitation (88%); and participation (78%).

1.3. Development of training materials

To provide healthcare workers and academics with up-to-date information on vaccines and immunisation

Trainingmaterialsarebeingdevelopedfordifferent levelsofthe immunisationprogramme,capturingtheneedsofallstaff.Thetrainingmaterialsshouldbeeasilyaccessibleandavailablefor the intended user. As the immunisation programme is characterised by rapid progression, regular revision of training materials will be necessary. Training modules will be developed/revised for vaccinology and MLM courses, as well as training material for healthcare workers andnurses.Specifictrainingmaterialwillbedevelopedfornewvaccineintroduction.

1.3.1. Development of vaccinology modulesStandard training materials for vaccinology courses are currently being developed. These training materials will facilitate the learning process during vaccinology cour-ses. In addition it will enable participants of these courses to use the modules in their lectures at health training institutions or to organise national in-service vaccinology courses.


The modules are developed according to the following reference format:

• Objectives(general,intermediateandspecificobjectives)

• PowerPoint presentations with explanatory notes

• Exercises

• List of key references

A workshop was organised by SAVIC/University of Limpopo in Pretoria, Johannesburg, from 21 to 24 January 2013, with participation from NESI/UAntwerp, WHO/AFRO and SAVIC/UniversityofLimpopo.Duringthisworkshop,themoduleshavebeenadvancedtothefinaldrafts and are ready for revision.

1.3.2. Development of mid-level management modulesMid-Level Management (MLM) courses aim to contribute to the reduction of morbidity and mortality due to vaccine-preventable diseases through the improvement of management of immunisation programmes in the African Region.

Standardised training modules - MLM modules - have been developed in 2004 by WHO/AFRO in collaboration with partners. These modules are being used to train national EPI managers, teachers, WHO/UNICEF focal points and other key immunisation partners at central, provincial and district level. The problem-solving approach is the basic teaching method used in all modules. These modules have facilitated the learning process during various inter-country and national MLM courses conducted between 2004 and 2011. In addition, these MLM modules have been used by teachers in their lectures at health training institutions.

As new vaccines, policies and technologies become available, the modules needed to be updated in order to incorporate this new information. Therefore, the MLM modules have been revised in 2011 and tested in selected countries in 2012. After incorporation of feedback aftertesting,themoduleshavebeenfinalisedin2013andareavailable inEnglish,Frenchand Portuguese.

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Acknowledgements

WHO Regional Office for Africa is grateful to all partners, especially WHO/HQ, UNICEF/HQ/ESARO & WCARO, WHO/UNICEF Country offices of Nigeria, Ethiopia, Ghana and Gambia, USAID/MCHIP, CDC/Atlanta, NESI and AMP, for their contribution to financing, preparation and completion of this updated module.

1.3.3. Development of audio-visual materialsTraining methods are evolving over the years and the classical classroom training could be complemented by the use of interactive resources (e.g. training DVD). Interactive resources can be made available on a CD-ROM or USB, and do not necessarily require an internet connection, as compared to e-learning. Therefore, the use of interactive resources might currently be more convenient to use in resource-poor settings. Interactive resources can be both used during face-to-face training to demonstrate certain techniques or procedures, as well as a self-learning tool. It has the advantage that the information given is consistent minimising the risk of messages being diluted, any section can be repeated at any time and procedures are easier to understand when they are demonstrated.


1.3.3.1. Development of EPI/IMCI interactive resource for African health care workers

Whilesignificantprogresshasbeenmade,communicablediseasesarestillresponsibleformillions of deaths in children in the WHO African Region each year. Therefore, it is vital that all healthcare workers in the Region have the knowledge and skills to prevent and treat the most common childhood illnesses. To achieve MDG4 of reducing child mortality by two third by 2015,comparedto1990,considerableeffortsneedtobemadetoimprovetheperformanceofhealthcareworkers,particularlythroughcost-effectivetrainingmethodsonthepreventionand treatment of childhood illnesses. Therefore, as recommended in the WHO/AFRO regional child survival strategy, the integration of immunisation and the management of childhood illnesses is of the highest importance.

At present, train-the-trainer methodology is the primary way of conveying knowledge to healthcare workers and nurses. This methodology comes with certain challenges. Firstly, there is inherent inconsistency in the output by the trainers. Therefore, the knowledge gained by students is also varied. Secondly, the great number of healthcare workers in the region makeitdifficulttokeepthemup-to-datewithchangesinimmunisationandIMCIprotocolsthroughworkshopandtrainingsessions.Andthirdly,arapidstaffturnovermeanstherearealwaysnewstaffneedingtobetrainedinEPIandIMCI.

Against this background, WHO/AFRO, in collaboration with NESI and ITEM Interactive, has developed an interactive resource on Immunisation and the Integrated Management of Childhood Illnesses (IMCI), designed for the training of healthcare workers.

The primary objective of the development of the EPI/IMCI interactive resource is to produce an efficient, cost-effective training tool that canbe used throughout theRegion. Thiswillimprove knowledge-retention, develop the skills of both experienced and trainee healthcare workers/nurses, increase their performance when delivering healthcare services and lead to a more satisfactory outcome for patients/clients.

This interactive resource is mainly targeting healthcare workers at the peripheral level, but can also be used for training at medical and nursing schools. The EPI/IMCI resource is ideal as a classroom aid, but can also be used as a self-learning tool. Video demonstrations are the next best thing to real-life demonstrations. The resource is always available on the computer for reference to check procedures.

ThetoolisavailableinFrench,EnglishandPortuguese,andwillbedistributedonUSBflashdrives or memory sticks, supported by a reference handbook. The content of the resource was drawn from existing WHO and local training materials to ensure consistency with the current training curriculum. This resource builds on the experience of ICATT (IMCI Computerised Adaptation and Training Tool) developed by WHO in 2008 with the aim of increasing the coverage of IMCI-trained healthcare workers. The WHO guide “Immunisation in Practice” was used as key reference document to develop the EPI component of this resource.

The EPI-IMCI interactive resource is a comprehensive training package including:

• Over two hours of video shot in Burkina Faso and Ghana;

• Seventeen video chapters with narrations in three languages;

• Questions and Answers section before and after each chapter to reinforce the key messages;

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• References and posters;

• Glossary;

• Transcript of the video chapters;

• ICATT programme; and,

• Certificateaftercompletionoftheprogramme.

The interactiveresource is ready forfieldtesting inselectedcountries in theWHOAfricanRegion,whichwilltakeplaceduringthefirst6monthsof2014.

1.3.3.2. Development of interactive resource for new vaccine introduction

The introduction of new vaccines worldwide has highlighted the need for comprehensive training materials for healthcare workers who have been assigned the task of running immunisation sessions.

Three new vaccines currently being introduced into the African region are pneumococcal, rotavirusandHPVvaccines.Achallengeistotrainhealthcareworkersquicklyandefficientlybefore the vaccines are in common use. To help achieve this, NESI, in collaboration with WHO, GAVI Alliance and ITEM Interactive developed an interactive video-based resource. The Ministry of Community Development, Mother and Child Health of Zambia kindly agreed forthefilmingtotakeplaceinZambia,andrecommendedChongweDistrictforallshootings.

The content of the resource was developed from existing WHO and local training materials to ensure consistency with the current training curriculum. Twenty to thirty minutes of video for each vaccine explain the need for the new vaccine and demonstrate how to store the vials, prepare for an immunisation session, administer the vaccines safely, communicate with the caregivers and safely dispose of used syringes, needles and vials.

Shootings were done in Chongwe, Zambia. Scenes in controlled environments as the districthospitalandruralhealthclinics include infantssufferingfromdiarrhealdiseaseandpneumonia and demonstrate the best technique for administering the vaccines. Scenes in villages of Chongwe show how to improve hygiene, how breastfeeding builds a baby’s immunityandhowtocareforsickchildrenathome.ForHPVvaccine,thefilmingwasdone


in theChongwebasicschool.During thefilming, the teamwassupportedbystaffof theMinistry of Community Development, Mother and Child Health of Zambia.

Comprehensive questions and answers at the end of each chapter of video reinforce the information presented and ensure it has been understood by the student or the healthcare worker. Additional references, posters, manuals and a glossary of terms have also been included on the resource. The interactive resource can be used for both face-to-face training and self-paced learning; is developed in English and French, and will be distributed on USB flashdrivesormemorysticksthroughoutsub-SaharanAfrica.

TheinteractiveresourceonnewvaccinesisreadyforfieldtestinginselectedcountriesintheWHOAfricanRegion.Thefieldtestingwilltakeplaceduringthefirst6monthsof2014,duringthe same time period and in the same countries as the testing of the EPI/IMCI interactive resource. Both tools are complementary and should be tested and distributed simultaneously.

Eventually, when proven to be appropriate, both resources will be passed on to health departments and training colleges in the African Region. The resources are not intended to take over the role of face-to-face teaching or to replace other training resources but to complement them.Thegreatnumberofhealthcareworkersand the fast turnoverofstaffin the African Region make this type of resources a valuable addition to healthcare worker training methodology.

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1.3.4. Stakeholder consultation workshop: developing training materials for in-service health care workers to strengthen delivery of immunisation services within the South African Expanded Programme on Immunisation, Johannesburg, South Africa, July 2013

A two day national stakeholders meeting was organized by the South African Vaccination and Immunisation Centre (SAVIC)/University of Limpopo and the National Department of Health in Johannesburg, South Africa, on 15 and 16 July 2013.

The workshop aimed to reach consensus on the development of immunisation training materials to improve and strengthen knowledge of current immunisation practices of in-service health care workers (doctors, nurses and other health professionals) working within the South African Expanded Programme on Immunisation.

The rapid development of innovations and new technologies in immunisation programmes requires that in-service health care workers are updated regularly if they are to cope with strategic changes and technical advancements they encounter in the workplace.

Specific objectives to reach consensus on:

• EPI training priority areas for which training materials should be developed;

• practical strategies to implement the training;

• training model to be adopted;

• a management model suitable for training in-service health care workers;

• and impact assessment tools.

The workshop was attended by more than 60 participants from the following organisations: National Department of Health, Provincial Departments of Health, WHO, UNICEF, academics of tertiary training institutions (EPI focal coordinators, teachers or tutors), statutory and regulatory bodies (South African Nursing Council, South African Pharmacy Council and the Health Professions Council of South Africa), the vaccine Industry, the Belgian and Flemish Development Cooperation, NESI and other interested parties.

NESI shared its experience on training material development for the African Region, especially the development of audio-visual training materials for new vaccine introduction.

Technical support 29

CHAPTER 2 Technical support: Institutional strenghtening

To ensure the sustainability of the Network’s activities, focal offices are being established in the different WHO Regions. Institutional strengthening will allow to share efforts in strengthening immunisation programmes through education and training.

Focaloffices,establishedatpartneruniversities/organisations,andNESIshallcollaborateinthe following areas:

• Conduct training needs assessment at pre- and in-service training institutions;

• In-service training: development of training materials and organisation/facilitation of vaccinology courses/workshops;

• Pre-service training: evaluate the curriculum in medical and nursing schools and assist the schools with updating their curriculum;

• Advocate for good interaction between the immunisation programme and academic institutions;

• Joint publications.

Focalofficeshave theopportunity toapply for theirown funding, inaddition to theseed-moneyprovidedbyNESI.ArepresentativeofeachfocalofficeparticipatesintheannualNESIOversight Committee Meeting as a core member.

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2.1. South African Vaccination and Immunisation Centre The South African Vaccination and Immunisation Centre (SAVIC), hosted at the University of Limpopo, Medunsa Campus, South Africa, was the first focal office to be established in January 2012.

SAVIC and NESI share a common goal of improving the quality and sustainability of immunisation programmes, through education and training; and have a long working relationship spanning over 10 years. SAVIC was established at Medunsa Campus of the University of Limpopo in2003.Itisanetworkofpartnersinthefieldofvaccinationandimmunisation.SAVICisaPublic Private Academic alliance between the South African Department of Health, Vaccine Industry, Academic institutions and other stakeholders. SAVIC activities are undertaken in close collaboration with the South African National Department of Health, NESI/UAntwerp, WHO and other partners. The strategic operational areas of SAVIC include Education and Training, Operational Research and Technical Support and Advocacy.

On 23 October 2013, history was made when SAVIC, through the University of Limpopo, hosted Vice-Minister-President of the Flemish Government and Flemish Minister for Innovation, Public Investment, Media and Poverty Reduction, Mrs Ingrid Lieten, at Medunsa Campus. It was a great honour and privilege for SAVIC to host such a prestigious event (see also 3.2.1).

In the area of Education and Training, SAVIC made great progress with its flagshipproject known as EduVax South Africa. This capacity building project of healthcare workers (HCWs) to strengthen delivery of immunisation services within the Expanded Programme on Immunisation (EPI) of South Africa, was initiated in 2011. EduVax South Africa aims to enhancetheeffectivenessofdiseasepreventionprogrammesthatreducetheannualburdenof vaccine-preventable diseases (VPDs) through improved pre-service training programmes and in-service continuing professional development of HCWs involved in EPI in South Africa.Thisproject isconductedwiththeNDoHwhich isalsothemajorbeneficiary,whileSAVICtakesonthecoordinatingrole.BeingthefirstprojectofitskindinAfrica,thereareanumber of preparatory steps before the implementation stage. The last two years saw a lot of groundwork being done through consultations with various stakeholders, especially the NDoH. A National Stakeholder Consultation Workshop was conducted in 2013 to collate input from the partners of the NDoH at large, in order to identify issues that need to be addressed in basic training of HCWs, challenges with the current training programmes, and implementation needs (see 1.3.4.).

SAVIC was tasked with the responsibility of developing training materials for South African HCWs to prepare them for the national introduction of the HPV vaccination programme for grade 4 girls, to prevent cervical cancer in later life. A total of nine training modules were developed, covering burden of disease, major properties of the bivalent HPV vaccine to be used in South Africa, vaccine delivery and safety, social mobilisation, advocacy and communication, data collection, monitoring and evaluation, and supervision.

Following the development of the HPV training modules, SAVIC was honoured to support the NDoH in training HCWs for the national implementation of the HPV vaccination programme.

Technical support 31

ThisexerciseinvolvedvisitingdifferentprovincesandconductingtrainingofMasterTrainers,whointurn,areexpectedtocascadethetrainingtothelevelofHCWsindifferentfacilities.SAVIC sees this as a huge responsibility of national importance that will see the country fully implementing the HPV vaccination programme to protect South African women against the fatal consequences of cervical cancer.

In the area of Operational Research, SAVIC continued to participate in selected research projects aimed at improving immunisation programmes and services. During 2013, SAVIC members published widely in peer-reviewed national and international journals, and participated in national and international scientific conferences on vaccine-preventablediseases.

SAVIC was very active in the area of Technical Support and Advocacy, the main objective of which is to allow rapid dissemination of up-to-date information on vaccines and immunisation at global, regional and national level. SAVIC continued as a faculty member of vaccinology courses and workshops regionally and internationally, providing technical expertise in various meetings and events. Furthermore, SAVIC members are active players in disseminating correct information on the benefitsofvaccines tocommunitiesandcounteringanti-vaccinationmessages, using mass media.

More information on SAVIC and its activities can be found on the SAVIC website (www.savic.ac.za).

2.2. Société Marocaine d’Infectiologie Pédiatrique et de VaccinologieSOMIPEV (Société Marocaine d’Infectiologie Pédiatrique et de Vaccinologie), is a non-profit association of paediatrics chaired by Prof Mohammed Bouskraoui, head of the paediatric department at CHU Mohammed VI, Marrakech. This association congregates all Moroccan expertise in the field of paediatric infectious diseases and vaccinology. Its objectives are to improve and share knowledge of paediatric infectious diseases and vaccinology, to strengthen health education for the prevention of infectious diseases in Morocco, to strengthen education and training in medicine and pharmacy, to create an international scientific platform in this field and to translate research into better prevention of paediatric infectious diseases in Morocco and to guide and assess the impact of national vaccination strategies of the Ministry of Health.

On Friday 13 September 2013, NESI organised a brainstorming seminar in collaboration with SOMIPEV, the Ministry of Health and ONDE (l’Observatoire National des Droits de l’Enfant) in Casablanca, Morocco. This in view of the on-going discussions regarding the development of training material to strengthen the national immunisation programme in Morocco. The

Annual report 2013

current status of training in both pre- and in-service health training institutions was discussed and a timing and planning for future actions were made. Representatives of the 5 Medical Faculties, the Military Hospital and Pasteur Institute, as well as an independent paediatrician, participated in the seminar.

At the end of this seminar NESI signed a Memorandum of Understanding (MoU) with SOMIPEV. This MoU establishes a partnership between SOMIPEV and NESI in order to joineffortsinstrengtheningtheknowledgeandskillsofacademics,EPImanagersandstaffand other health professionals in all activities related to immunisation in Morocco through education and training.

Both partners prepared a joint work plan (2013-2014) in which a promising roll out is planned of the training of EPI managers, nurses and personnel of the mobile units across all regions in Morocco in 2014.

Networking and advocacy 33

On 13 and 14 November 2013, SOMIPEV and NESI organised in Marrakech, Morocco, a consensus seminar on the development of training materials to strengthen immunisation services in the National Immunisation Programme in Morocco.

The seminar was attended by participants from differentregionsofMoroccoincluding:16teachersof the 5 Faculties of Medicine (Casablanca, Fès, Marrakech, Oujda and Rabat); teachers of Nursing Schools of 22 different regions of Morocco; 4members of the Ministry of Health; as well as 3 members of NESI.

The purpose of this seminar was to bring together key drivers of vaccination in Morocco to update them on global vaccination policies and strategies, including GIVS and GVAP, to inform them about the current status of training in Morocco in both pre- and in-service health training institutions and to obtain a consensus on the content of the training manual to be developed.

The overall goal was to improve and standardize the teaching of vaccination in the existing training programme and the development of a training manual to strengthen immunisation services. The specific objectives of this seminar were to review the technical content ofvaccination courses – both at the Faculties of Medicine and the Nursing schools – and to ensure the relevance of training objectives, the use of active teaching methods and techniques, a balance between theoretical and practical sessions, availability of training materials and proper evaluation.

Duringthefirstpartofthis2-dayseminar,theparticipantssharedtheirviewsandexperiencesand expressed the need for education and training in immunisation, at both pre- and in-service level.

The second part of the seminar was dedicated to workshops on planning of vaccination, monitoring of progress indicators, monitoring of immunisation activities, management of the cold chain and vaccines, good management of an immunisation session, surveillance of preventabledisease,communicationwithstakeholdersandbeneficiariesandencouragingimmunisation activities in the community. These workshops led to high quality oral presentations constituting a working basis for the development of training materials.

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2.3. University of JordanDiscussions on institutional collaboration between the University of Jordan and NESI/UAntwerp have started during 2013, and the agreement will be finalised in 2014. As a first joint project, an Immunisation newsletter/website is being developed and hosted on the website of the University of Jordan.

Vaccines and the success of vaccination programmes are a very important health intervention that is considered to be one of the most important preventive health measures. While this used to be limited to a very small number of vaccines, often administered to primarily children in infancy or early childhood, the number of vaccines that are routinely recommended to children as well as the extension to include older children, adolescents and adults, has more than doubled in recent years and is expected to increase with time as newer vaccines are introduced.

In order to help the medical community and healthcare workers, as well as the general public to be well-informed, a newsletter will be published online to have the maximum distribution and to help upgrade the knowledge of the public about vaccines and immunisation. The issues to be discussed will be mainly directed at the EMRO Region, however it will include news itemsaboutother regions, aswell asprovide timely informationabout thedifferentvaccines that are being introduced in the Region and other parts of the world.

It is further noted that due to the fact that Jordan and Lebanon have been experiencing outbreaks of some diseases which were controlled in the past, such as measles, and the re-emergence of polio in Syria, the subject of immunisation is being further discussed on a wide scale since mass vaccination is being implemented in order to minimize the risk of such diseases. It is now more important than ever that information about vaccines be more readily available to all stakeholders including the general public, policy makers, medical and nursing staffaswellaspharmacistsinordertocounterthemanyrumoursthatarebeingcirculatedabout the “dangers” of vaccines and vaccination.

The immunisation newsletter will be updated on a three-monthly basis or sooner if required.


CHAPTER 3 Networking and advocacy

NESI works with both the public and private sector to develop and deliver high-quality training programmes. A network is created for sharing experiences and best practices. Through networking and advocacy NESI aims to align the different stakeholders in immunisation to achieve faster and coordinated introduction of new and under-utilised vaccines.

NESI is committed to providing up-to-date information on vaccines and immunisation. The NESI website (www.nesi.be) plays an important role in the dissemination of this information. The website hosts high-quality training materials, which can be downloaded if required.

A mailing list linked to the human resources and alumni database has been established, in order to send out regular news updates and updated training materials.

Participating in networking meetings is an important opportunity for NESI to discuss and plan collaborative activities, to share experiences with other immunisation partners, and to receive latest updates and recommendations on vaccines and immunisation, which can immediately be incorporated in the training/teaching activities.

3.1. Meetings

3.1.1. Strategic Advisory Group of Experts Meeting, Geneva, Switzerland, April and November 2013

The Strategic Advisory Group of Experts (SAGE) Meetings were organised by WHO from 9 to 11 April 2013, and from 5 to 7 November 2013, in Geneva, Switzerland. SAGE advises WHO on overall global policies and strategies, ranging from vaccine research and development, to delivery of immunisation services and linking immunisation with other health interventions. SAGE usually meets twice a year and reports directly to the Director-General of WHO.

ThefirstsessionofSAGEusuallycoversthereportsfromWHO/IVBandtheGAVIAlliance.This is followed by regional reports. Other topics addressed by SAGE during 2012 are summarized in the table.

SAGE is an excellent opportunity for NESI to network but also for understanding the rationale underpinning most of WHO’s recommendations on vaccines and immunisation. These evidence-based arguments subsequently can be rapidly included in NESI’s training/teaching activities enriching discussions with the most recent information, especially relevant for vaccinology courses and immunisation management courses.

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Topics addressed by the Strategic Advisory Group of Experts during 2013

Topics discussed at SAGE April 2013

Topics discussed at SAGE November 2013

Report from WHO/IVB Report from WHO/IVB

Report from GAVI Alliance Report from GAVI Alliance

Report from other Advisory Committees on Immunisation:• Global Advisory Committee on

Vaccine Safety• Immunisation Practices Advisory

Committee

Reports from other Advisory Committees on Immunisation: • Global Advisory Committee on

Vaccine Safety • Immunisation Practices Advisory

Committee• Expert Committee on Biological

Standardisation• Immunisation and Vaccine

Related Implementation Research Advisory Committee

Dengue Global Polio Eradication Initiative

Global polio eradication initiative Decade of Vaccines/Global Vaccine Action Plan Monitoring

Yellow fever Pandemic and pre-pandemic influenza vaccine

Non-specific effects of vaccines on childhood mortality

Measles and rubella elimination

Overcoming vaccine hesitancy Smallpox vaccines

Optimisation of Hib immunisation schedules

Immunisation supply chain and logistics: key challenges and future directions

Update on RTS,S/AS01 and the malaria vaccines pipeline

Sentinel site surveillance


3.1.2. The best shot: reaching 22 million missed children. A seminar on accelerating access to vaccination, Oslo, Norway, October 2013

The best shot: reaching 22 million missed children, a seminar on accelerating access to vaccination, was organised by Médecins Sans Frontières (MSF) on 14 October 2013 in Oslo, Norway.

Whilesignificantprogresshasbeenmadeinimmunisation,stillmorethan1.5millionchildrendie of vaccine-preventable diseases each year. Barriers to expanding access to vaccination include service delivery obstacles at country and community level, vaccine products that are not well adapted to the local context, and the high cost of vaccines.

The seminar aimed to stimulate discussion among stakeholders across the vaccination community on the barriers to assessing vaccination, and to examine innovative solutions to address challenges related to vaccine products, pricing and delivery.

Various vaccination stakeholders working in the field were invited and presented theirexperiences and considerations on what is needed to reach all children. During two round table debates it was discussed how to ensure appropriate vaccines, how to improve product thermo-stability,howtoensureaffordablevaccinesandsustainablevaccinationprogrammes.

3.1.3. Inter-country meeting on measles/rubella control and elimination, Jordan, Amman, November 2013

The inter-country meeting on measles/rubella control and elimination was organised by WHO/EMRO from 17-20 November 2013 in Amman, Jordan.

The meeting was attended by 66 participants from the following countries: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Republic of South Sudan, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, Yemen, United Arab Emirates; and included national EPI Managers, national officers formeaslessurveillance,andnationalofficers responsible formeasles laboratorysurveillance.Other participants included RTAG and NITAG members, WHO, UNICEF, CDC, GAVI Alliance and NESI.

The objectives of the meeting included:

• Review countries’ progress towards achieving the regional measles elimination target

• Reviewandfollow-uponimplementationofthedifferentcomponentsofregionalstrategyfor measles elimination

• Review and update the national plans for strengthening measles and rubella elimination and control programme

Plenary sessions discussed the global and regional updates towards measles elimination, as well as the progress in achieving and maintaining high population immunity against measles

Annual report 2013

and rubella. A session was included on enhancing rubella and congenital rubella syndrome (CRS) control and elimination in the EMR.

Group work sessions reviewed the situation of Member States in measles and rubella elimination in relation to population immunity and the surveillance progress in achieving the targets of measles and rubella surveillance performance indicators.

Countries are recommended to have policies and operational plans in place to deliver a catch-updosetochildrenwhomissedthefirstdoseoftheMeaslesVaccine,andtoensurethat all children receive two doses of the Measles Vaccine by the age of two.

In addition, a session on the Polio Eradication Endgame strategy included discussions on strengthening routine immunisation and the introduction of the Inactivated Polio vaccine (IPV).

3.1.4. Meeting of the Regional Technical Advisory Group on immunisation, Amman, Jordan, November 2013

The Meeting of the Regional Technical Advisory Group (RTAG) in the Eastern Mediterranean Region was organised by WHO/EMRO on 21 November 2013 in Amman, Jordan.

The participants included NITAG chairpersons of the following countries: Jordan, Libya, Pakistan, Palestine, Qatar, Sudan, Syria, Tunisia, United Arab Emirates; as well as RTAG members, and representatives from WHO, SAGE, CDC and NESI.

The objective of the meeting was to update NITAG chairpersons and RTAG members on progress and constraints facing EPI and the expected role of NITAG for supporting EPI.

The sessions addressed the following topics:

• Progress towards measles elimination in the EMR

• Scaling up use of rubella vaccine

• Developing regional target for rubella/CRS elimination

• Introduction of new vaccines in countries of the EMR

• Strengthening the National Immunisation Technical Advisory Groups

NESI was invited to give a presentation on “Strengthening the NITAGs for supporting EPI to achieve the immunisation targets”.

Since nearly all of the Member States in the Region have an established NITAG, the regional strategy will focus on strengthening the functions and quality of decision making support processes of NITAGs. They are encouraged to support EPI programmes and decision makers, as well as considering collaborating with health training institutions to support human resources needs of the national immunisation programmes.


3.2. Symposia

3.2.1. Symposium 10 years NESI, Antwerp, Belgium, April 2013The Network for Education and Support in Immunisation (NESI) was established in late 2002, at the Department of Epidemiology and Social Medicine, University of Antwerp, Belgium. To celebrate its tenth anniversary, a Symposium with international guest speakers was organised on 22 April 2013 at the University of Antwerp.

ThefirstpartoftheSymposiumfocussedonscientificpresentationsandthesessionwasopened by the Head of Department of Epidemiology and Social Medicine, Prof Joost Weyler. Prof André Meheus from the University of Antwerp presented the challenges related to new vaccineintroduction.ProfJeffreyMphahlelefromtheUniversityofLimpopoinSouthAfricaexplained the role of HPV vaccines in controlling cervical cancer; and Prof Tandakha Dieye from Cheikh Anta Diop University in Senegal gave an overview of the development status of malaria vaccines. The presentations were followed by a panel discussion.

The second part of the Symposium included the Academic Session. The welcome was given by the vice-rector, Prof Johan Meeusen, of the University of Antwerp. The Dean of the Faculty of Medicine and Health Sciences, Prof Paul Van Royen, of the University of Antwerp, presented on the importance of immunisation within an integrated healthcare approach. This was followed by two presentation on the status of immunisation in the WHO African and Eastern Mediterranean Region, and presented respectively by Dr Richard Mihigo (WHO/AFRO) and Dr Ezzeddine Mohsni (WHO/EMRO). The activities and achievements of NESI were presented by Dr Carine Dochez. The Academic Session concluded with a keynote lecture on the future of vaccines and vaccinations by Prof Paul-Henri Lambert from the University of Geneva in Switzerland.

More than 100 participants from various institutions and organisation attended the Symposium to celebrate 10 years NESI. Participants included also the students from the MSc programme at the Institute of Tropical Medicine.

The Symposium received media coverage with 2 radio interviews and an article in the “Artsenkrant”.

Some impressions of our Symposium are shown in our Highlight 2013.

3.2.2. Vaccinology Symposium, Hermanus, South Africa, November 2013

The 10th Vaccinology Scientific Congress was organised by the National Institute for Communicable Diseases, from 13 to 15 October 2013, in Hermanus, South Africa. This Symposium has evolved from a national event into a reference meeting for the Southern African sub-region.

The latest research, be it basic, clinical, epidemiological or operational research, was presented through state-of-the-art reviews by academic experts or young researchers and discussed with an audience consisting of EPI managers, academics and health workers from the private sector.

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Sessions were devoted to:

1. Research on new vaccines, e.g. HIV and TB vaccines and a call for more local research on immunology of vaccines. A Centre for Vaccines and Immunology has been established in the National Institute for Communicable Diseases, which shall focus on cellular immunology including immunogenetics and on correlates of immunity and tolerance to vaccine antigens;

2. Maternal(influenza,pertussis)andneonatal(hepBbirthdose)immunisationofwhichtheintroduction in the South African schedule is still under discussion;

3. New developments in routine immunisation: the country decided on HPV vaccine introduction with two doses in 9-10 year old girls with eventually a booster dose at the age of 14 years. Through a tender process the bivalent HPV vaccine was selected with a price similar to the one obtained by the PAHO revolving fund;

4. Surveillance of vaccine-preventable diseases: a 54-58% reduction after vaccine introduction for rotavirus diarrhoea between 2009 and 2011 with intussusception surveillance in place; andanobservedvaccineeffectivenessof24%againstpresumedbacterialpneumoniainHIV-positive children of the PCV vaccine;

5. Discussion on the Decade of Vaccines and the implementation of recommendations of SAGE in the context of Southern Africa; and

6. Public and private immunisation practices.

NESI’s contribution to theSymposiumhasbeenand remains significant,with a key-notepresentation on “Immunisation schedules”, a particularly complex issue in those countries in which the private sector is also much involved in immunisation.

NESI’s collaboration with SAVIC/University of Limpopo, the Department of Health, and national and regional vaccine experts from the whole of Southern Africa is also greatly enhanced.


3.3. Advocacy Events 3.3.1. Ministerial visit, South Africa, November 2013

From 21 till 26 October 2013, HE Ingrid Lieten, Vice-Minister-President and Minister of Innovation, Public investment, Media and Poverty Reduction, Government of Flanders, visitedSouthAfricaintheframeworkoftheofficialBelgianEconomicMissionpresidedoverby HRH Princess Astrid of Belgium. NESI participated in several visits of the academic part of this mission.

On 23 October 2013, SAVIC, through the University of Limpopo, had the privilege to host HE Mrs Ingrid Lieten, at Medunsa Campus. The Minister was accompanied by a high-powered delegation of academics from various universities in Flanders.

We appreciate and thank you for selecting the University of Limpopo as one of the strategic partners during your official visit in South Africa, despite your hectic programme”, remarked Professor Mbudzeni Sibara, Deputy Vice-Chancellor, in his welcome address.

“Today, I have had the opportunity to witness a number of presentations that testify to the excellent scientific collaboration between Flanders and South Africa. The joint projects for applied research and capacity building in the health sector, in particular regarding the introduction of new vaccines, are clear examples of the real benefits from international cooperation. I would like to end with a word of thanks to SAVIC and NESI for organising this event and sharing with us the fruits of their cooperation”, remarked Minister Ingrid Lieten.

SAVIC and NESI presented their collaborative activities in the area of capacity building to strengthen the national immunisation programme.

Visit of Mrs Ingrid Lieten to University of Limpopo

Vice-Minister-President of the Flemish Government & Flemish Minister for Innovation, Public Investment, Media and Poverty Reduction

thClinical Pathology Building 5 Floor, DVC Boardroom

Wednesday, 23 October 2013

UNIVERSITY OF LIMPOPOMedunsa Campus

PROGRAMME

NETWORK FOR EDUCATION AND SUPPORT IN IMMUNISATION

South AfricanVaccination &Immunisation

Centre

Visit of Mrs Ingrid Lieten to University of LimpopoVice-Minister-President of the Flemish government & Flemish Minister for

Innovation, Public investment, Media and Poverty Reduction

University of Limpopo, Medunsa CampusClinical Pathology Building, 5th Floor, DVC Boardroom

Wednesday, 23 October 2013

Master of Ceremony(To Be Announced)

14:00 - 14:20 Arrival & Refreshments

14:20 - 14:25 Welcome & Introduction

Ÿ University Executive

14:25 - 14:50 Scientific collaborations between University of

Limpopo and Flemish Institutions

South African Vaccination and Immunisation Centre (SAVIC) at University of Limpopo (UL) & Network for Education and Support in Immunisation (NESI) at University of Antwerp (UA)

Ÿ Prof. Dr. Jeffrey Mphahlele

SAVIC/UL

Ÿ Em. Prof. Dr. André Meheus

NESI/UA

University of Limpopo IUC Programme funded by VLIR-UOS

Ÿ Prof. Dr. Kingsley Ayisi

VLIR IUC Local Co-ordinator/UL

Remarks by the University of Antwerp

Ÿ Prof. Dr. Johan Meeusen

DVC/UA

Mrs Ingrid Lieten - Minister of Innovation, Belgium

14:50 - 15:00 Remarks

Ÿ Mrs Ingrid Lieten

Flemish Minister for Innovation, Public Investment,

Media and Poverty Reduction, Belgium

15:00 - 15:05 Vote of thanks

Ÿ University Executive

15:05 - 15:15 Group photo / Interviews

15:20 Departure

Vision Statement

To be a leading African university focused on the developmental needs of its communities and

optimising academic excellence and innovativeness.

Mission Statement

A University which responds actively:

a) to the development needs of its students, its staff members and its communities,

b) through relevant and high quality higher education and training, research and engagement, and

c) in partnership and in collaboration with its different stakeholders.

Motto

Finding solutions for Africa.

Annual report 2013

Ninth NESI Oversight Committee Meeting, Antwerp, Belgium, April 2013

NESI is a partnership between the University of Antwerp and the public and private sector. An Executive Secretariat coordinates and implements activities for the network. The Executive Secretariat reports to the Oversight Committee, which advises on strategy and budget allocation, and reviews outcomes. The Oversight Committee is composed of representatives from this partnership, representatives from partner universities and international health organisations and alliances, and international vaccinology experts.

Specifically,thecommittee:

• shapes a strategic vision and direction for NESI;

• advisesonthestrategytofollowanddefinespriorities;

• stimulates/fosters participation of GAVI partners and others in the implementation of NESI activities;

• reviews the plans, evaluates the postulated goals and endorses the work plan and the related budget allocation;

• facilitates networking and collaboration with other bilateral and multilateral stakeholders engaged in the area of capacity building for immunisation programmes;

• ensures the academic freedom of NESI in planning and implementing its activities;

• verifiestheindependencyoftheactivitiesorganisedbyNESIinrelationtoitssponsors.

The 9th NESI Oversight Committee Meeting was organised in Antwerp, Belgium, on 23 April 2013.

The Executive Secretariat reported to the Oversight Committee on the implementation of the PlanofActionandthefinancialreportfortheyear2012.Afterthediscussionofthereports,the secretariat presented the work plan for 2013. Based on the discussions of the report for the year 2012 and the work plan for the year 2013, the members of the committee formulated recommendations and approved the NESI work plan and the related budget allocation for the year 2013.

NESI Oversight Committee Meeting 43

Members of the NESI Oversight Committee

Core Members Affiliation

Prof Paul-Henri Lambert Chairman Professor, CMU Centre of Vaccinology, University of Geneva, Switzerland

Prof Mohammed Bouskraoui Professor and Head Paediatrics, CHU Mohammed VI, Morocco

Prof Tandakha Dieye Head Immunology Unit, Le Dantec University Teaching Hospital, University Cheikh Anta Diop, Senegal

Dr Carine Dochez Programme Director, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium

Prof Anwar Hoosen Head of Department of Medical Microbiology and Virology, University of the Free State, South Africa

Prof Najwa Khuri-Bulos Professor and Chairman Paediatrics Department, Jordan University Hospital, Jordan

Dr Raj Kumar Senior Programme Officer, GAVI Alliance Secretariat, Switzerland

Dr Heidi Larson Senior Lecturer, London School of Hygiene and Tropical Medicine , UK

Prof André Meheus Senior advisor NESI, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium

Prof Jeffrey Mphahlele Professor and Head Virology, Head of SAVIC, University of Limpopo, South Africa

Dr Afisah Zakariah Ag. Director, Policy, Planning, Monitoring and Evaluation Directorate, Ministry of Health, Ghana

Non-core Members

Dr Karin Hardt Director, Worldwide Vaccinology, Vaccine Education and Medical Training, GlaxoSmithKline Vaccines, Belgium

Dr François Meurice Head, Global Medical Affairs – Scientific Affairs and Medical Education, GlaxoSmithKline Vaccines, Belgium

Secretariat

Mrs Katrin Verboven Project Assistant NESI, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium

Annual report 2013

Publications

Special Issue to Vaccine: Sexually transmitted infections: Vaccine development for global health. Volume 32, Issue 14, Pages 1523-1640 (20 March 2014). Edited by Nathalie Broutet, Carolyn D. Deal and Uli Fruth.

Editorial: Vaccines for sexually transmitted infections: past, present and future. Fruth U, Deal C, Dodet B, Meheus A. Vaccine 2014; 32 (14): 1525-1526.

More than30bacterial, viral andparasiticpathogensareclassifiedassexually transmitted infections(STIs). These STIs are a major global cause of acute illness, infertility, long-term disability and death, with serious medical and psychological consequences for millions of men, women and infants. Two existing vaccines, against hepatitis B virus and human papillomavirus (HPV), have shown that it is possible to developsafeandeffectivevaccinesagainstSTIs.Buildingonthatsuccess,developmentofvaccinesagainst other STIs can now be envisioned as an achievable goal. Although previous STI experimental vaccines against herpes simplex virus (HSV), Neisseria gonorrhoeae (gonorrhea), Treponema pallidum (syphilis), and Chlamydia trachomatis (chlamydia) were unsuccessful, recent progress in technology provides importantreasonsforre-consideringthedevelopmentofsafeandeffectivevaccinesagainstSTIs. Recognizing the exciting potential for new STI vaccine development to address the impact of STIs on global sexual and reproductive health and the need for new prevention strategies, the World Health Organization (WHO) and the U.S. National Institute of Allergy and Infectious Diseases (NIAID) co-edited this special issue of the journal Vaccine. To catalyze interest and action related to STI vaccine research and development,thisspecialissueprovidesstateoftheartreviewsonvaccinedevelopmentforfiveprioritySTIs: HSV-2, chlamydia, gonorrhea, trichomoniasis, and syphilis. Manufacturing and programmatic considerations forSTI vaccinedevelopment and introductionare alsoaddressed.The first articlebyGottlieb et al. provides an overview of the global burden of STIs and their sexual, reproductive, and maternal-child health consequences. The article also addresses the limitations of available interventions tocontrolSTIs,emphasizing theneed fornewSTI vaccines foreffectiveSTIpreventionandcontrol.In the following article, Garnett describes mathematical modelling related to the theoretical impact of STIvaccinesanddemonstratesthatthesevaccineswouldbecost-effectiveandtheirdevelopmentaworthwhileinvestment.ThenextarticlesaddressthescientificadvancesunderpinningdevelopmentofthefivespecificSTIvaccines.First,Brotmanetal.describetheunique immunologicalcharacteristicsof the reproductive tract, providing insight into the compartmentalization of the mucosal immune responses, the role of the microbiome, the impact of sex hormones, and the interactions among all of thesefactors.TwoarticlesstresstheurgentneedaswellassignificantopportunitiesforthedevelopmentofvaccinesagainstHSV:(1)Johnstonetal.reviewpreviousHSVvaccinetrialsandoutlinenewscientificfindingsofferingnewdirectionsforHSVvaccinedevelopment;and(2)Knipeetal.reportonanNIAIDworkshoponthenextgenerationofHSVvaccines.Inaddition,twoarticlesoutlinethescientificadvancesproviding new hope for development of a chlamydia vaccine. Hafner et al. describe current knowledge and future vaccine directions for control of genital chlamydial infection, while Mabey et al. review the lessons learned from efforts to develop a vaccine against ocular chlamydia (trachoma). Increasinggonococcal antimicrobial resistance has led to new urgency to develop a vaccine against gonorrhea, and Jerse et al. summarize technological advances that could lead to making this vaccine a reality [14]. Smith and Garber give an update of prospects for development of a vaccine against Trichomonas vaginalis infections, and Cameron and Lukehart discuss challenges and opportunities for development ofaneffectivevaccineagainstsyphilis.Finally,anarticlebyDochezetal.presentsanupdateonthenextgenerationofHPVvaccines.ImplementationofHPVvaccineoffersseverallessonsforotherSTIvaccinesthat may also be delivered in early adolescence. Hawkes et al. discuss issues related to informed consent and other ethical and human rights considerations for adolescents, building on the experience with HPV vaccines. The paper by Rosenthal et al. focuses on communication with parents and adolescents and the role of health care professionals in the uptake of STI vaccines. Vaccine development is a long and complex process. For her article, Dodet interviewed vaccine producers, biotech companies, and funding agencies to assess the forces determining interest and involvement of the private sector in research and development of STI vaccines. Finally, based on the articles in this special issue of Vaccine and

Publications 45

on conclusions of a 2013 WHO technical consultation on STI vaccines, a roadmap was developed to outlinethekeyprioritiesforglobalSTIvaccinedevelopmentandintroduction.Inthefinalarticleofthisspecial issue, Rees and Holmes stress the importance of the STI vaccine roadmap as a long overdue intervention for STI control and put forward a call to action. With this special issue, WHO and NIAID encourage partners to respond to this call to action by accelerating progress toward new STI vaccines.

1. Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 2014; 32 (14): 1527-1535.

2. GarnettGP.Thetheoreticalimpactandcost-effectivenessofvaccinesthatprotectagainstsexuallytransmitted infections and disease. Vaccine 2014; 32 (14): 1536-1542.

3. Brotman RM, Ravel J, Bavoil PM, Gravitt PE, Ghanem KG. Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. Vaccine 2014; 32 (14): 1543-1552.

4. Johnston C, Koelle DM, Wald A. Current status and prospects for development of an HSV vaccine. Vaccine 2014; 32 (14): 1553-1560.

5. Knipe DM, Corey L, Cohen JI, Deal CD. Summary and recommendations from a National Institute of Allergy and Infectious Diseases (NIAID) workshop on “Next Generation Herpes Simplex Virus Vaccines”. Vaccine 2014; 32 (14): 1561-1562.

6. Hafner LM, Wilson DP, Timms P. Development and status and future prospects for a vaccine against Chlamydia trachomatis infection. Vaccine 2014; 32 (14): 1563-1571.

7. MabeyDCW,HuV,BaileyRL,BurtonMJ,HollandMJ.Towardsasafeandeffectivechlamydialvaccine: Lessons from the eye. Vaccine 2014; 32 (14): 1572-1578.

8. Jerse AE, Bash MC, Russell MW. Vaccines against gonorrhoea: current status and future challenges. Vaccine 2014; 32 (14): 1579-1587.

9. Smith J, Garber GE. Current status and prospects for development of a vaccine against Trichomonas vaginalis infections. Vaccine 2014; 32 (14): 1588-1594.

10. Dochez C., Bogers J-P, Verhelst R., Rees H. HPV vaccines for the prevention of cervical cancer and genital warts: an update. Vaccine 2014; 32 (14): 1595-1601.

11. Cameron CE, Lukehart SA. Current status of syphilis vaccine development: need, challenges, prospects. Vaccine 2014; 32 (14): 1602-1609.

12. Hawkes S, Kismodi E, Larson H, Buse K. Vaccines to promote and protect sexual health: policy challenges and opportunities. Vaccine 2014; 32 (14): 1610-1615.

13. Hofstetter AM, Rosenthal SL. Health care professional communication about STI vaccines with adolescents and parents. Vaccine 2014; 32 (14): 1616-1623.

14. Dodet B. Current barriers, challenges and opportunities for the development of effective STIvaccines: point of view of vaccine producers, biotech companies and funding agencies. Vaccine 2014; 32 (14): 1624-1629.

15. Broutet N, Fruth U, Deal C, Gottlieb SL, Rees H, on behalf of participants of the 2013 STI Vaccine technical Consultation. Vaccines against sexually transmitted infections: the way forward. Vaccine 2014; 32 (14): 1630-1637.

16. Rees H, Holmes K. The STI vaccine roadmap – a long overdue intervention. Vaccine 2014; 32 (14): 1638-1639.

Annual report 2013

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